Universiteit Leiden

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The end of life as a subject for debate

Most students do not have to deal with death on a daily basis. A Bachelor Honours Class about this specific topic seems to be a special experience: the discussions about end-of-life care are tough, and students are broken out of their comfort zone. They nevertheless agree upon one thing: these are all very important discussions to have.

The fourth seminar of the course Anthropological Perspectives on Dying and End-of-Life Care is about palliative care. Palliative care is focused on making the lives of patients who are never going to get better as comfortable as possible. This type of care is relatively new. This end-of-life care, executed in hospices, is being offered in the Netherlands only since 1991. Before that, it has always been a private matter, often driven by ecclesiastical institutions.

International differences

Research conducted by the teacher of the class, Annemarie Samuels, shows that there are big differences to be found internationally. In the Netherlands, the prospect of dying is usually being discussed very openly with both the patient and their family. However, in for example Asian countries, it can be quite unusual to share this kind of information with the patient. During the seminar, Samuels – who conducted research in many countries including Indonesia – shows how people deal with the loss of a family member globally.

‘Discussing these rather tough topics is an important part of this course’, says Samuels. She gives the students the floor and creates room for confidential discussions in which students from different cultural backgrounds and with different opinions can speak freely. This leads to interesting discussions, such as the question of whether administering pain relief medicine, such as morphine, could be considered an act of euthanasia. The answer to this question can be very different from patient to patient, especially when accounting for religious requirements as well.

A sensitive issue

A fourth-year medical student explains that these discussions are precisely what makes this course so interesting. ‘Learning about palliative care in different cultures complements the knowledge I gained during my studies. After the message ‘there’s nothing we can do for you anymore’, it really isn’t over yet. There is still so much you can do. I find it very interesting to pay particular attention to this aspect, mostly because this isn’t extensively discussed in my regular study Medicine.’

A third-year anthropology student chose this course because she may want to continue in medical anthropology. ‘I do still think it’s a sensitive topic. One which you usually don’t have to deal with. The open and confidential atmosphere during these classes makes it possible to talk about this, which is very important. It is good to think about these topics, and maybe also to discuss this among family members.’

Issoria

The students are more or less halfway through the course. At the end of the course, they have to submit a paper on a topic that is in line with the discussions held in class. The students have to conduct their own research for this. They will visit hospice Issoria (Leiden), and they will interview someone who is experienced with end-of-life care. For the students, such a visit is uncharted territory. Perhaps that is exactly the reason why it will be good for the students to get acquainted with this.

Text: Rosa van der Velde
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